Republic of the Philippines Province of Aklan IBAJAY DISTRICT HOSPITAL Ibajay, Aklan PHILHEALTH ACCREDITED GUIDELINES ON THE USE

OF HOSPITAL AMBULANCE AUTHORIZED USE 1. Transfer of patient from the hospital to other health facility. 2. Transport of patient to other diagnostic center (back and forth). 3. Transfer of patient from other health facility in Kalibo to IDH is allowed if the ambulance is in Kalibo. 4. Transport of bedridden patient from the patients residence to IDH. 5. Transport of bedridden patient from the hospital to the patients residence within Ibajay and Nabas. 6. Transport of bedridden patient from the hospital to the airport or seaport. 7. In instances where the patient for transfer died en-route to the referral hospital, the ambulance can go back to the Ibajay District Hospital in order for the IDH Doctor on duty to pronounce the death of the patient or the ambulance can go to any nearby hospital for the pronouncement of death. In the event that the patient was brought to other hospital, then the hospital ambulance is no longer responsible in bringing back the patients dead body. 8. In special circumstances, when en-route to the hospital where the patient is being referred either in Roxas or Iloilo, the patient died in the ambulance, as special consideration due to distance, the ambulance vehicle may be used in transporting back the patient to Ibajay. 9. In special circumstances, for transport of the medical supplies and drugs and medicines that are urgently needed by the hospital. 10. In exigency of service, for transport of hospital personnel from their residences when they are urgently needed to report for duty especially during the occurrence of natural calamities, disasters and other emergencies. AMBULANCE FEE 1. Ambulance Rental as per Provincial Ordinance: IDH to Kalibo P 1,000 IDH to Roxas 2,500 IDH to Iloilo 3,000 IDH to Other Areas P ___/km 2. Special consideration is given to most Aklanon patients for transport from Ibajay to Kalibo where in the patient/ patients folks/representative is allowed to pay P500 for the purchase of diesel fuel for the ambulance. However, for patients going to Roxas or Iloilo, the patient/patients folks/representative should pay the corresponding ambulance rental to cover the fuel cost as well as the maintenance of the vehicle as per Provincial Ordinance. 3. In cases where there are two or more patients who are transported at the same time, then the ambulance fee shall be shared equally by the said patients. 3. Payment of ambulance fee: During office hours (Mon Sun, 8:00 AM 12:00 NN, 1:00 PM 5:00 PM) Payment should be given at the Administrative Office Official Receipt of the diesel fuel is given to the patient/patients folks/representative in case of patient going to Kalibo and can be

claimed from the office the following day; a copy of the request for ambulance use which serves as the provisional receipt will be given upon payment; this payment will be used for the purchase of diesel fuel for the ambulance In cases of transport to Iloilo or Roxas, the Official Receipt of the hospital is issued upon payment of ambulance rental Refueling of the ambulance shall be arranged by the Administrative Office After office hours Payment should be given to the Nurse on duty and a copy of the request for ambulance use which serves as the provisional receipt is issued Official Receipt as mentioned above can be claimed during office hours the following day The ambulance driver is not authorized to transact for payment from the patient, patients folks/representative. He is also not authorized to get the payment from the Nurse on duty for the refueling of the ambulance. Payment can only be given to him if with written instructions or verbal instructions (personal or through telephone) from the Administrative Officer or the Chief of Hospital. PERSONS AUTHORIZED TO NOTIFY THE AMBULANCE DRIVER 1. During office hours (Mon Sun, 8:00 AM 12:00 NN, 1:00 PM 5:00 PM) Administrative Office Personnel on duty 2. After office hours: Doctor on duty Nurse on duty Nursing attendant on duty Security guard on duty IW on duty Important Note: The ambulance driver upon notification should be told of the reason for transport and the severity of the patients condition. AMBULANCE CALL 1. All calls to the ambulance driver for request for ambulance use should be recorded in the logbook. 2. The time of call and the time the ambulance driver arrived should also be recorded in the logbook. 3. In case the ambulance driver cannot be contacted after 3 to 5 attempts of calling, the hospital personnel assigned should ask the Security Guard on duty or the IW on duty to go to the residence of the ambulance driver and personally tell him of the need for ambulance use. 4. In case the ambulance driver is not around and cannot be contacted then the hospital personnel assigned should notify Mr. Rex S. Robles (Administrative Officer IV) and he will be the one to find a way for the patients transport. 5. In case the ambulance is not in Ibajay upon notification, the ambulance driver should inform the hospital so that other mode of transport (use of other ambulance) can be arranged.

6. In case where the driver will not go back directly to the hospital upon going back from transport of patient, the ambulance driver should notify the hospital of his whereabouts. PROCEDURE 1. The Doctor on duty will make a Referral Slip and call the health facility where the patient is being referred. 2. For patients for diagnostic purposes and own request for transfer, the Nurse on duty will ask the patients folks/representative for the preferred ambulance to use (whether hospital ambulance or municipal ambulance). If they prefer to use to municipal ambulance, the patients folks/representative should be the one to ask the permission of the Municipal Mayor. If they prefer to use the hospital ambulance, then it is the duty of the hospital personnel to notify the ambulance driver of the hospital. For emergency cases, the hospital ambulance is the preferred mode of transport of patients. 3. The Nurse on duty will fill-up the Request for Ambulance Use Form and instruct the patients folks/representative to bring the said form together with the Referral Slip to the Administrative Office. 4. The patients folks/representative will be asked to pay the corresponding amount for ambulance fee. In extreme emergency cases wherein due to the patients condition, immediate transfer is needed and the patient/patients folks/representative cannot pay the ambulance fee, then the patients folks/representative should sign a Promissory Note with the date of payment indicated. 5. The hospital personnel will notify the ambulance driver of the request for ambulance use. 6. Upon arrival to the hospital, the ambulance driver will prepare a Trip Ticket to be signed by the Chief of Hospital or the Doctor on duty, Administrative Officer IV or the Administrative Personnel on duty, and the patients folks/representative. 7. The Security Guard on duty should note on the logbook the time the Ambulance Driver arrived in the hospital, the time the ambulance leave the hospital for transport of patient and the time the ambulance returned to the hospital. 8. The Nurse on duty will call the Nursing Attendant on duty and the IW on duty and prepare the patient for transfer from the ward/room to the ambulance vehicle. 9. Transport of patient to the referred facility. 10. In case where the patient who is referred to Kalibo is immediately referred to Iloilo or Roxas, the ambulance driver should notify the hospital of the said plan. The ambulance driver should also inform the patients folks/representative of the corresponding ambulance fee. If the payment is made, he should turn-over the payment to the Cashier upon his arrival to the hospital during office hours or on the following day if after office hours. AMBULANCE CONDUCTION 1. Conduction of patients for transfer by the hospital personnel (doctors, nurses, nursing attendants, or midwife) is allowed in the following cases: a. Emergency cases as defined below b. For diagnostic purposes where a conducting nurse is specifically requested by the diagnostic center being referred to

2. Conduction should be authorized by the Chief of Hospital or the doctor on duty and the Chief Nurse or the nurse on duty. A travel order should be issued for the hospital personnel who will be conducting and should be recommended by the Chief Nurse or the nurse on duty and approved by the Chief of Hospital or the doctor on duty. 3. Conduction of patients during emergency cases mentioned above should be done by the hospital personnel (doctor, nurse, nursing attendant, midwife) on duty. In cases where there is only one doctor, one nurse and one nursing attendant or midwife who are on duty, then the nurse on duty should look for the one who is off duty that is available who will conduct the patient. In such case, the patient/patients folks/representative cannot demand for conduction by the on-duty personnel since there are more patients who needed care who will be left in the hospital as compared to only one patient for conduction. In cases where the nurse on duty cannot find anyone who will conduct the patient, then the patients folks/ representative will be the one to find the one who will conduct the patient on the ambulance. In cases where ambulance conduction by a health personnel is advised and no one is available to conduct then the patients folks/representative should sign a waiver where the transport of the patient to other health facility is without the company of qualified health personnel. 4. The patient/patients folks/representative should pay the following conduction fee in lieu of the medical services given to the patient during transport: (Subject to the Governors Approval & SP Resolution???) Ibajay to Kalibo Doctor P500 Nurse 250 Nursing Attendant/Midwife 200 Ibajay to Iloilo Doctor P5000 Nurse 2500 Nursing Attendant/Midwife 2000 Ibajay to Roxas Doctor P4000 Nurse 2000 Nursing Attendant/Midwife 1500 Conduction fee to other areas should be agreed by both the hospital personnel concerned and the patient/patients folks/representative. The above fees apply to the hospital personnel who are off duty and may apply also to on duty personnel as agreed upon by both parties. The patient/patients folks/representative will not be given an official receipt for the medical services given during conduction since the said service fee serves as the professional fee of the health personnel who will render the service.

COMPLAINTS 1. Complaints regarding the ambulance and the ambulance driver should be made in writing and address to the Chief of Hospital through the Administrative Officer IV. 2. Complaints should be recorded in the logbook and should be acted upon immediately. 3. Complaints aired over the radio should be answered after thorough investigation and data gathering. DEFINITION OF TERM

Emergency Cases: The hospital considers the following cases as emergency which may warrant transfer of patient upon the discretion of the attending physician or the doctor on duty: 1. Trauma cases With head injury and neurologic deficits With multiple injuries With fractures, especially open fractures With spinal cord injury Stab wounds/Hacked wounds Gunshot wounds 2. OB/Gyne cases OB patients(nulligravid or multigravid) in labor or PROM Pre-eclampsia or hypertensive OB patients Patients with severe vaginal bleeding Patients with ectopic pregnancy 3. Surgical cases Acute abdomen Acute appendicitis Acute cholecystitis with cholelithiases Incarcerated Hernia 4. Medical cases Severe Respiratory Distress Neurologic cases Stroke (GCS Score < 10) Seizure Disorder Acute Myocardial Infarction Severe GI Bleeding Poisoning Dengue Hemorrhagic Fever Stages 3 and 4 5. Other cases as determined by the Attending Physician or the Doctor on duty Prepared by: Dr. Mary Jane S. Sualog Robles Medical Specialist I Noted by: Dr. Mary Jean A. Gelito OIC Chief of Hospital Mrs. Luzvilla D. Ascao Chief Nurse Mr. Rex S.

Administrative Officer IV

Recommending Approval: Mr. Rex Victor B. Consemino PGADH, EEDD Approved by:

HON. CARLITO S. MARQUEZ Provincial Governor